Victor N Petzinka1, Christian Endisch2, Kaspar J Streitberger3, Farid Salih4, Christoph J Ploner5, Christian Storm6, Jens Nee7, Christoph Leithner8. 1. Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: victor.petzinka@charite.de. 2. Department of Neurology, Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: christian.endisch@charite.de. 3. Department of Neurology, Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: josche.streitberger@charite.de. 4. Department of Neurology, Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: farid.salih@charite.de. 5. Department of Neurology, Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: christoph.ploner@charite.de. 6. Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: christian.storm@charite.de. 7. Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: jens.nee@charite.de. 8. Department of Neurology, Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: christoph.leithner@charite.de.
Abstract
OBJECTIVE: To investigate the clinical course and early prognostic markers in cardiac arrest (CA) patients discharged from the intensive care unit (ICU) in an unresponsive wakefulness syndrome (UWS) or coma. METHODS: 89 patients were identified from a prospective CA database. Follow-up was conducted by telephone interviews with legal guardians, evaluation of re-admission and rehabilitation reports assessing core elements of the coma recovery scale-revised (CRS-R). Somatosensory evoked potential (SSEP) and electroencephalography (EEG) original recordings were re-analyzed, the gray-white-matter ratio (GWR) was determined from brain computed tomography (CT) and neuron-specific enolase (NSE) serum concentrations were retrieved. RESULTS: Follow-up was successful for 32/50 (64%) patients admitted between 2001-2009 and 31/39 (79%) between 2009-2015. Median ICU stay was 27 days (IQR 20-36). Neurological improvement beyond UWS was found in 2 of 63 patients. Among 61 patients with successful follow-up and no improvement, NSE serum concentrations within the reference range, SSEP amplitudes above 2.5 μV or continuous reactive EEG were found in 5%, 3% and 2% of those tested. NSE > 90 μg/L, SSEP ≤ 0.3 μV, highly malignant EEG or GWR < 1.10 were found in 44%, 49%, 35% and 22% of those tested. CONCLUSIONS: Neurological recovery was rare in CA patients discharged in UWS after prolonged ICU treatment. Status epilepticus requiring prolonged deep sedation is one potential reason for delayed awakening. Sensitivity for established poor outcome parameters to predict persistent UWS early after CA was moderate. SSEP, EEG and NSE may indicate absence of severe HIE early after CA.
OBJECTIVE: To investigate the clinical course and early prognostic markers in cardiac arrest (CA) patients discharged from the intensive care unit (ICU) in an unresponsive wakefulness syndrome (UWS) or coma. METHODS: 89 patients were identified from a prospective CA database. Follow-up was conducted by telephone interviews with legal guardians, evaluation of re-admission and rehabilitation reports assessing core elements of the coma recovery scale-revised (CRS-R). Somatosensory evoked potential (SSEP) and electroencephalography (EEG) original recordings were re-analyzed, the gray-white-matter ratio (GWR) was determined from brain computed tomography (CT) and neuron-specific enolase (NSE) serum concentrations were retrieved. RESULTS: Follow-up was successful for 32/50 (64%) patients admitted between 2001-2009 and 31/39 (79%) between 2009-2015. Median ICU stay was 27 days (IQR 20-36). Neurological improvement beyond UWS was found in 2 of 63 patients. Among 61 patients with successful follow-up and no improvement, NSE serum concentrations within the reference range, SSEP amplitudes above 2.5 μV or continuous reactive EEG were found in 5%, 3% and 2% of those tested. NSE > 90 μg/L, SSEP ≤ 0.3 μV, highly malignant EEG or GWR < 1.10 were found in 44%, 49%, 35% and 22% of those tested. CONCLUSIONS: Neurological recovery was rare in CA patients discharged in UWS after prolonged ICU treatment. Status epilepticus requiring prolonged deep sedation is one potential reason for delayed awakening. Sensitivity for established poor outcome parameters to predict persistent UWS early after CA was moderate. SSEP, EEG and NSE may indicate absence of severe HIE early after CA.
Authors: Jerry P Nolan; Claudio Sandroni; Bernd W Böttiger; Alain Cariou; Tobias Cronberg; Hans Friberg; Cornelia Genbrugge; Kirstie Haywood; Gisela Lilja; Véronique R M Moulaert; Nikolaos Nikolaou; Theresa Mariero Olasveengen; Markus B Skrifvars; Fabio Taccone; Jasmeet Soar Journal: Intensive Care Med Date: 2021-03-25 Impact factor: 17.440
Authors: Jakob I Doerrfuss; Alexander B Kowski; Martin Holtkamp; Moritz Thinius; Christoph Leithner; Christian Storm Journal: J Neurol Date: 2021-04-19 Impact factor: 4.849
Authors: Pedro Kurtz; Christian Storm; Marcio Soares; Fernando Bozza; Carolina B Maciel; David M Greer; Leonardo S L Bastos; Ulisses Melo; Bruno Mazza; Marcelo S Santino; Roberto Seabra Lannes; Ana Paula Pierre de Moraes; Joel Tavares Passos; Giulliana Martines Moralez; Robson Correa Santos; Maristela Medeiros Machado; Saulo Fernandes Saturnino; Ciro Leite Mendes; Arthur Oswaldo Vianna; Jorge Salluh Journal: Crit Care Explor Date: 2021-07-14